porozendoОстеопороз и остеопатииOsteoporosis and Bone Diseases2072-26802311-0716Endocrinology Research Centre10.14341/osteo9962porozendo-9962Research ArticleНаучный обзорReviewФункциональный гипопаратиреоз: причины, патогенез, клиническое значение в патологии костной тканиFunctional hypoparathyroidism: causes, pathogenesis, clinical significance in Bone tissue pathologyhttps://orcid.org/0000-0002-4394-8446НуруллинаГузель МихайловнаNurullinaGuzel M.

ассистент 

assistant professor

dalllila@mail.ruhttps://orcid.org/0000-0003-1876-2516АхмадуллинаГузяль ИлгисовнаAkhmadullinaGuzyal I.

к.м.н., доцент

MD, PhD, assistant professor

guzal-work@mail.ruhttps://orcid.org/0000-0002-3977-5247МасловаИрина СергеевнаMaslovaIrina S.

к.м.н.

MD, PhD

irinams1810@yandex.ru<p>ФГБУ ВО "Ижевская государственная медицинская академия" Минздрава России</p>Россия<p>Izhevsk State Medical Academy</p>Russian Federation<p>БУЗ УР "Первая республиканская клиническая больница&raquo; Министерства здравоохранения Удмуртской республики</p>Россия<p>The First Republican Clinical Hospital</p>Russian Federation2018261220182123035Copyright &#x00A9; Нуруллина Г.М., Ахмадуллина Г.И., Маслова И.С., 20182018Нуруллина Г.М., Ахмадуллина Г.И., Маслова И.С.Nurullina G.M., Akhmadullina G.I., Maslova I.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.osteo-endojournals.ru/jour/article/view/9962

Паратиреоидный гормон (ПТГ) регулирует поддержание концентрации кальция в сыворотке в узких пределах посредством прямого воздействия на кости, почки и косвенно за счет влияния на желудочно-кишечный тракт, также регулирует метаболизм фосфора. В ответ на снижение сывороточного кальция и витамина D развивается вторичный гиперпаратиреоз, что приводит к повышению костной резорбции. Однако далеко не во всех случаях недостаточности (или дефицита) витамина D или гипокальциемии наблюдается повышение паратгормона выше референсных значений. Супрессированный или неадекватно нормальный ПТГ при этих состояниях обозначается как функциональный гипопаратиреоз. Для объяснения функционального гипопаратиреоза предлагаются различные теории: дефицит магния, кишечный кальцистат, более низкие референсные значения для ПТГ плазмы, по сравнению с теми, которые в настоящее время предоставляются изготовителем диагностических наборов, биологические вариации витамин D-связующего протеина. Однако в настоящее время ни одна из них не является общепринятой. Клиническое значение функционального гипопаратиреоза может заключаться в том, что недостаточность витамина D, гипокальциемия, гипомагниемия связаны с риском перелома независимо от ПТГ.

Parathyroid hormone (PTH) regulates the maintenance of serum calcium concentration in strict limits through direct effects on bones and kidneys and indirectly due to the effect on the gastrointestinal tract. PTH also regulates phosphorus metabolism. Secondary hyperparathyroidism develops in response to a decreased serum calcium and vitamin D levels, leading to an increased bone resorption. However, the increase in parathyroid hormone above the reference values is not observed in all cases of vitamin D deficiency or hypocalcemia. Supressed or inadequately normal PTH in these conditions is referred to as functional hypoparathyroidism. Various theories have been suggested to explain the functional hypoparathyroidism: magnesium deficiency, intestinal calcistat, lower reference values for plasma PTH compared to current cut off interval, biological variations of vitamin D-binding protein. However, at present none of these theories are generally accepted. The clinical significance of functional hypoparathyroidism may be that vitamin D deficiency, hypocalcemia, and hypomagnesemia are associated with a risk of fracture, regardless PTH level.

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The authors declare that there are no conflicts of interest present.